Old News (prior to 1/1/23): JW modifier
CMS has uniformly over the past years required that the JW modifier be appended to Part B drugs and biological J codes to show the amount of the drug that was used and wasted from a single-dose container or single-use package. One of the most common uses in Orthopaedics is Collagenase used for the treatment Dupuytren’s contracture.
Practices report:
The J code for Collagenase is:
J0775 – Injection, collagenase, clostridium histolyticum, 0.01 mg: 0.01 mg = 1 billable unit
Practices report on the claim form:
J0775 0.58 to indicate the actual dose injected.
J0775 0.32 JW to indicate the amount wasted.
What’s New? Effective January 1, 2023, with an implementation date of July 1, 2023, the additional requirement of adding the JZ modifiers to single-use package or single-dose containers with no discard.
So, what is the JZ modifier?
The JZ modifier (Z= Zero drug amount discarded/not administered to any patient). This indicates to CMS that a Part B drug or biological from a single-dose container or single-use package was administered without wastage.
The use of the JZ modifier was introduced in the final rule. CMS instructed that both modifiers could be appended beginning in January 2023, but gave leeway to July 1, 2023, for full implementation.
What is Important to Know:
- Part B provides payment for the discarded amount, as well as the dose administered, up to the amount of the drug shown on the vial or package labeling. So, CMS wants to know if you are administering all or part of the drug/biological from a single-use package or single-dose vial.
- CMS does not allow multiple patient use from these types of single-use or single-dose packages/containers.
- Inventory your medications to determine which Part B drugs or biologicals are single-use or single-package. Another more common drug that may be given, especially in pediatrics, is Botox.
- Ensure the most concise medication is purchased; for example, if a provider always gives 20 mg of a Part B drug or Biological, you will not want to purchase single-use/single-dose packaging that contains 40 mg. This would result in a wastage of 20 mg with every administration.
- Documentation will be needed to support single-use packages/containers and whether the entire medication was administered or wasted.
- Make sure the billing staff is aware of the need for the JW or JZ modifier as indicated. Claims without the JZ or JW modifier may be subject to audit after July 1 for Drugs and Biologicals that meet this requirement.
- CMS communicated appropriate claims without the JW or JZ modifier will be subject to claims editing when not used appropriately.
